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• Attestation Regarding Protected Health Information Potentially Related to Reproductive Health Care

  Attestation regarding a requested use or disclosure of protected health information potentially related to reproductive health care.

• 2025 HMSA Akamai Advantage Dual Care (PPO D-SNP) Application Instructions

  Fill out this form if you've just become eligible for HMSA Akamai Advantage Dual Care or are enrolling during the open enrollment period.

• 2025 HMSA Individual Plan Application Instructions

  Get the application for 2021 HMSA Individual Plan Application here.

• 2025 HMSA Medicare Advantage Application Instructions

  Fill out this form if you've just become eligible for HMSA Medicare Advantage or are enrolling during the open enrollment period.

• Essential, Optimal, and Metallic Formulary Coverage Determination Request

  Need a prescription drug that’s not on your formulary? Get instructions on how to start the request process with your doctor.

• Dental Appeals

  You can ask us to recheck a decision about your health plan or prescription drug coverage for services or benefits you've received.

• QUEST Integration Formulary Exception Request

  Need a prescription drug that's not on your formulary? Get instructions on how to start the request process with your doctor.

• Request For Insurance Commissioner External Review

  You can ask to have an independent review organization look over your appeal if you think we made a mistake.

• Commercial Member Form to Appeal

  You can ask us to recheck a decision about your health plan or prescription drug coverage for services or benefits you've received.

• HSTA Travel Reimbursement Benefit Request Form

  Find out if you qualify for HSTA travel reimbursement by filling out this form.

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